Question

James is 5 years old and was diagnosed with new onset of tonic–clonic seizures. He will be sent home on Dilantin 240 mg PO b.i.d and Diastat 10 mg PR (rectal Valium) for breakthrough seizures.

a. What are the priority teaching needs for James and his parents?

b. How does Dilantin prevent seizures, and why is it a good choice for James?

c. What is Diastat (rectal Valium) and how should it be given?

Answer 1

Teachings to be given to James parents as he is suffering from tonic clonic seizures are as follows:-

1) clearing the floor area from hard and sharp objects.

2) placing something soft under child's head.

3)Do not hold the child and try to stop his / movements.

4)Do not try to force open child's mouth and put anything there.

5)Turn the child to sideways and loosen the clothes around neck to ease breathing difficulty.

6) Do not give anything to say or drink until the child is fully alert plus note the duration of seizures.

7)call ambulatory services and if prescribed by doctor give diastat rectal gel .

8) we need to educate the parents about various symptoms which can occur after child has suffered a seizure like temporary memory loss, confusion, embarrassment or frustration,depression, fear. They may notice some injuries or bruises, bitten tongue, bowel or urinary incontinence, difficulty in communicating, weakness. We should also educate them about the risk of sudden unexpected death in epilepsy mainly during prolonged seizure while sleeping.

Dilantin is a well know and old drug of choice for epilepsy it is anticonvulsant works by slowing down the impulses in brain due to which seizure occur. It's mechanism of action is modulation of sustained repetitive firing of neutrons by direct inhibition and blockage of voltage gated sodium channels in neuronal cell membrane and by delay of cellular reactivation.it remains the drug of choice for tonic clonic seizures as it can be used insidious intravenous in emergency and is rapidly distributed in blood.

Diastat is a gel type formulation of diazepam used for rectal administration. How it should be used should be taught by a doctor or nurse to a caregiver. Steps to give diastat are as follows:-

1) Turn the patient on their side so they are facing you(who has to give it).

2)Take the medicine out of package and check the dose to be given to the patient prescribed by the doctor.

3) Remove the cap from the syringe and make sure the seal pin is removed with the cap.

4)put lubricated jelly on tip of syringe and fix patients clothes bend his upper leg forward so that rectum can be seen.

5) Spread the cheeks of buttocks and gently insert the tip of the syringe into the rectum.

6)Push the planet on the syringe in and slowly count 3 .Count 3 again before removing the syringe. Then squeeze the buttocks together and count to 3 to prevent any leakage of medicine. Fix the clothes of patient back to normal and follow the doctor's recommendation of observation of patient after administration of medicine.